The following are instructions for preparing the VS Form 16-4 for submission to VS. 

Exporters are responsible for having their importer confirm prior to shipment that the 

certificate meets the requirements of the importing country. VS cannot guarantee that 

importing countries won’t require additional or more specific information. 

Port: point of embarkation, last port in the U.S., “Any US port” may be noted, unless the IREGS 

for the country of destination specifies otherwise. 

Date: Leave blank: to be completed after submission to the VS office only. 

Certification Number: Leave blank: to be completed after submission to the VS office only. 

Additional Declarations: The exporter must draft this section consistent with information 

available on the IREGS or where the IREGS does not contain relevant information, based on 

information the importer confirms is required bythe importing country’s pertinent animal health 

ministry. Exporters should consult with the VS office regarding additional requirements for 

formatting and verification of information included in this section. 

Only the JUL 2022 version of the VS Form 16-4 available on the previous page may be used. 

Unless otherwise indicated on the relevant IRegs page, the following statement should be the first 

statement in this section: This is to certify that rinderpest, foot-and-mouth disease, classical swine 

fever, swine vesicular disease, African swine fever, and contagious bovine pleuropneumonia do 

not exist in the United States of America. 

Name of Endorsing Official: Leave blank: to be completed after submission to the VS office only. 

Title of Endorsing Official: Leave blank: to be completed after submission to the VS office only. 

Name and Address of Exporter: If the exporting company is not located in the US, the certificate 

must still indicate the consignment is shipped from the US. 

Name and Address of Consignee: Name and address, including country, to which the 

consignment is being shipped. This address must be outside the continental United States and 

U.S. territories. 

Product: Type, quantity, unit of measure, and animal species of origin. The VS office may not 

endorse a certificate that contains additional information in the section. 

Identification: Information to identify shipment (lot number, shipping container number, order 

number, etc.) This blank is not considered part of the certified declaration of the certificate. 

Conveyance: Shipping vessel, flight number, “ocean vessel,” etc. This blank is not considered 

part of the certified declaration of the certificate. 
 

 

 

 

 

 

 

 

The following are instructions for preparing the VS Form 16-4A for submission to VS. 

The VS Form 16-4A may only be utilized in conjunction with a VS Form 16-4. When more 

space is required, the VS form 16-4 is continued on the VS Form16-4A. Only the JUL 2022 

version of the VS Form 16-4 available on the previous page may be used. When the VS Form 

16- 4A is used, the VS Form 16-4 must reference the continuation. For example, if Additional 

Declarations continue on the 16-4A, the comments on the 16-4 must end with “See page 2.” 

Page number: Use format “X of Y.” If there are 3 pages total (one VS Form 16-4 and two VS 

Form 16-4As), the 2nd page should be numbered “2 of 3” and the third page should be numbered 

“3 of 3.” The VS office will print page 2 on the back of the first sheet of security paper prior to 

endorsement. 

Date: Leave blank: to be completed after submission to the VS office only. 

Certification Number: Leave blank: to be completed after submission to the VS office only. 

Continuation space: All continuation comments must identify which block is being continued. 

For example, a continuation of the Additional Declarations block of the VS Form 16-4 would 

start with “Additional Declarations continued.”